Upper GI Hemorrhage (UGIH) causes significant morbidity and mortality, although endoscopic hemostasis has revolutionized management of these patients. Despite standard endoscopic treatment and high dose proton pump infusions, 27% of patients in referral hospitals with upper gastrointestinal bleeding (UGIB) from ulcers or other non-variceal UGI lesions (NVUGI) have refractory or recurrent bleeding in a recent RCT by our group. Potential risk factors for NVUGI bleeding lesions were large ulcers (≥ 15 mm), fibrotic base, Dieulafoy's lesions, anastomotic ulcers, coagulopathies, cirrhosis, severe co-morbidities, and residual arterial blood flow under stigmata after endoscopic hemostasis. Such patients with severe rebleeding after standard endoscopic hemostasis usually required angiography (by interventional radiologists-IR) or surgery for definitive hemostasis. A new, large, FDA approved, over-the-scope hemoclipping device (OTSC® System OVESCO Endoscopy, Tübingen, Germany) can capture larger amounts of tissue and larger underlying arteries than standard hemoclips and potentially could improve endoscopic hemostasis of such bleeding lesions.